RESUMEN
A hospital-based study was conducted along the Thai-Myanmar border to provide greater knowledge of the causes of febrile illness and to determine what zoonotic and vector-borne emerging infectious diseases might be present. A total of 613 adults were enrolled from June 1999 to March 2002. Cases were classified based on clinical findings and laboratory results. An etiologic diagnosis was made for 48% of subjects. Malaria was the most common diagnosis, accounting for 25% of subjects, with two-thirds Plasmodium falciparum. Serologic evidence for leptospirosis was found in 17% of subjects. Other etiologic diagnoses included rickettsial infections, dengue fever, and typhoid. The most frequent clinical diagnoses were nonspecific febrile illness, respiratory infections, and gastroenteritis. Clinical associations were generally not predictive of etiologic diagnosis. Apparent dual diagnoses were common, particularly for malaria and leptospirosis. Findings have been used to modify treatment of unspecified febrile illness in the area.
Asunto(s)
Fiebre/epidemiología , Fiebre/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Dengue/diagnóstico , Dengue/epidemiología , Femenino , Fiebre/etiología , Fiebre/virología , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Humanos , Leptospirosis/diagnóstico , Leptospirosis/epidemiología , Malaria/diagnóstico , Malaria/epidemiología , Masculino , Melioidosis/diagnóstico , Melioidosis/epidemiología , Persona de Mediana Edad , Mianmar/epidemiología , Fiebre Q/diagnóstico , Fiebre Q/epidemiología , Infecciones por Rickettsia/diagnóstico , Infecciones por Rickettsia/epidemiología , Tailandia/epidemiología , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/epidemiología , Fiebre Tifoidea/diagnóstico , Fiebre Tifoidea/epidemiologíaRESUMEN
We evaluated the proportion of variants of circumsporozoite protein (cp) gene 26 and cp29 antigenic epitopes of Plasmodium falciparum infecting patients among 3 provinces in western Thailand, in addition to published variants from Gambia. The proportion of patients coinfected with cp26 and cp29 strains was significantly higher in patients reporting to malaria clinics in Tak than in Kanchanaburi and Ratchaburi and higher in Kanchanaburi than in Ratchaburi. In western Thailand, coinfection with cp26 and cp29 appears to increase with increasing latitude. There were also significant differences in proportion of these variants among Thai provinces and Gambia. An association of patient human leukocyte antigen (HLA) class II genotype was associated with P. falciparum strains. There were significant associations among the HLA-DQA alleles in patients, the province of origin, and cp variants of P. falciparum.